Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Ένα από τα βασικά χαρακτηριστικά της ομόζυγης β-θαλασσαιμίας είναι η οστεοπάθεια, η οποία αποτελεί μία πολυπαραγοντική διαταραχή, που δεν έχει πλήρως διευκρινισθεί. Μελετήσαμε τους οσφυϊκούς σπονδύλους 48 ασθενών με τις μεθόδους Dual-Energy X-ray Absorptiometry (DXA) και Quantitative Computed Tomography (QCT), και εστιάσαμε στις δομικές οστικές ιδιότητες, όπως προσδιορίζονται από την υψηλής ευκρίνειας Υπολογιστική τομογραφία (HRCT). Οι τιμές της οστικής πυκνότητας (BMD values) εκφράσθηκαν ως Z-scores και τα αποτελέσματα συσχετίσθηκαν. Εκτιμήθηκε η επίδραση της ηλικίας, του φύλου, του τύπου της θαλασσαιμίας και των ορμονικών παραγόντων στις τιμές ΒΜD. Αξιολογήσαμε, με βάση την HRCT, την ακεραιότητα του φλοιού και τον αριθμό και πάχος των δοκίδων της σπογγώδους ουσίας. Με βάση τον αριθμό των δοκίδων ταξινομήσαμε τους ασθενείς σε κλίμακα τριών βαθμίδων. Τα αποτελέσματά μας έδειξαν ότι ο συνολικός επιπολασμός της οστεοπόρωσης με την μέθοδο DXA ήταν 44 % και με την QCT 6 %. Και οι δύο μέθοδοι έδειξαν μία αρνητική συσχέτιση μεταξύ της ηλικίας και της BMD, ενώ οι ορμονικοί παράγοντες παρουσίασαν συσχετίσεις τόσο με τις μετρήσεις της QCT όσο και με τις αντίστοιχες της DXA. Ο συντελεστής συσχέτισης μεταξύ της BMD της DXA και της σπογγώδους BMD της QCT ήταν 0,545 (p<0,001) ενώ η αντίστοιχη τιμή για τα Ζ-scores ήταν 0,491 (p<0,001). Η ομαδοποίηση των ασθενών σε φυσιολογικούς, οστεοπενικούς και οστεοπορωτικούς, με βάση το Ζ της QCT, ήταν σε καλύτερη συμφωνία με την ταξινόμηση με βάση τον αριθμό των δοκίδων (K=0,209, p=0,053), σε σύγκριση με την ομαδοποίηση σύμφωνα με το Ζ της μεθόδου DXA (K=0,145, p=0,120). Η εκτίμηση του φλοιού με την HRCT έδειξε διακοπές στη συνέχειά του σε 15 ασθενείς. Και οι δύο μέθοδοι δείχνουν μία επιδείνωση της οστεοπόρωσης με την πρόοδο της ηλικίας. Η ανεπάρκεια των ορμονών συσχετίζεται με την θαλασσαιμική οστεοπόρωση, ενώ η οτπική εκτίμηση του φλοιώδους οστού δείχνει ότι οι ενδιάμεσου τύπου θαλασσαιμικοί πάσχουν σε μεγαλύτερο βαθμό από τους ασθενείς με μείζονα μορφή θαλασσαιμίας. Με τον αριθμό των δοκίδων ως δείκτη οστεοπόρωσης, φαίνεται ότι η QCT μπορεί να εκτιμήσει την οστεοπάθεια καλύτερα από την DXA. Δεδομένου ότι η QCT έχει την ικανότητα να μετρήσει την οστική πυκνότητα του σπογγώδους και φλοιώδους οστού, ξεχωριστά, μπορεί να παρέχει πρώιμη ένδειξη του ποιο από τα δύο μεταβάλλεται πιο γρήγορα και σε τι βαθμό. - / Osteopathy, as a major feature of homozygous beta-thalassaemia, is a multifactorial disorder, not fully understood. We studied the lumbar vertebrae of 48 patients using Dual-Energy X-ray Absorptiometry (DXA) and Quantitative Computed Tomography (QCT), and we focused on structural properties, assessed by High Resolution Computed Tomography (HRCT). Bone Mineral Density (BMD) values were expressed as Z scores and the results were correlated. The effect of age, sex, type of thalassaemia and hormonal factors on BMD was assessed. We estimated, with HRCT, the cortex integrity and the number and thickness of trabeculae; the latter were classified to a three-grade scale. Our results showed the overall prevalence of osteoporosis to be 44 % with DXA and 6 % with QCT. Both techniques revealed an inverse correlation between age and BMD, whereas hormonal factors demonstrated associations with QCT and DXA measurements. The correlation coefficient between DXA’s BMD and QCT’s trabecular BMD was 0.545 (p<0.001) whereas the corresponding value for Z scores was r=0.491 (p<0.001). The classification of the patients into normal, osteopenic and osteoporotic categories, using QCT’s Z, was in better agreement with the assignment based on trabecular number (K=0.209, p=0.053) than the classification using DXA’s Z (K=0.145, p=0.120). Cortex evaluation by HRCT showed discontinuity in 15 patients. Both methods indicate a progression of osteoporosis with age. Hormonal deficiency is associated with thalassaemic osteoporosis whereas the visual estimation of cortex indicate that TI could be more affected than TM. Using the trabecular number as an indicator of osteoporosis, it seems that QCT may evaluate osteopathy better than DXA. Since the former has the ability to measure trabecular and cortical BMD separately, it could give early indication of which changes more rapidly and to what degree.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Cardiovascular disease (CVD) is one of the major health issues of our time. The prevalence of CVD is increasing, both in industrialized and in developing countries, and causes suffering and a decreased quality of life for millions of people worldwide. CVD can have multiple etiologies, but the main underlying cause is atherosclerosis, which causes blood clot formation and obstructs vital arteries. Multiple risk factors of atherosclerosis have been identified, and body fatness is one of the most important ones.  The main aims of this thesis were to investigate the relation between body fatness and: CVD risk factors (paper I), incident stroke (paper II), and overall mortality (paper III). The results showed that abdominal obesity is strongly associated with both CVD risk factors and stroke incidence (papers I-II). The results also suggested that a substantial part of the association between increased body fat and stroke can be explained by an increase in traditional stroke risk factors associated with increased body fat (paper II). A gynoid fat distribution, with a high share of fat located around the hip, is, on the other hand, associated with lower risk factor levels in both men and women, and with a decreased risk of stroke in women (papers I-II). This illustrates the importance of assessing the overall distribution of body fat rather, than solely focusing on total body fatness. In elderly women, total body fat was found to be associated with increased survival, while abdominal fat moderately increased mortality risk (paper III). Lean mass (fat-free mass) was strongly associated with increased survival among elderly men and women (paper III). Erythrocyte sedimentation rate (ESR) is an indicator of inflammation and, possibly, an indicator of atherosclerotic disease. In paper IV, the relationship between ESR in young adulthood and the later risk of myocardial infarction (MI) was studied. Results showed that higher levels of ESR were associated with a higher MI risk, in a dose-responsive manner, and was independent of other well-established risk factors. In summary, both total and regional fat distribution are associated with CVD risk factors and stroke, but do not seem to correspond to an increase in mortality risk among the elderly. Also, inflammation, detected as an increase in ESR, is associated with long term MI risk in young men.

Este trabalho teve como objetivo verificar se a técnica de impedância bioelétrica (IB) identifica as modificações da composição corporal em mulheres no período pós-parto. Participaram do estudo 47 mulheres (&#8805; 18 anos), nas quais foram avaliadas massa livre de gordura (MLG), massa gorda (MG) e percentual de gordura corporal (%GC) pelos equipamentos IB_Tanita BC 533; IB_RJL 101 e por absorciometria de raio X de dupla energia (DXA). Todas as avaliações foram feitas no mesmo dia. Posteriormente, as mulheres foram categorizadas em dois grupos: com perda ponderal (n= 24) e com ganho ponderal (n= 22). Os valores médios das alterações da composição corporal (CC), foram comparados intra-métodos e em relação ao método padrão-ouro (DXA) através de teste T-pareado. A concordância entre as diferenças das alterações da CC obtidas pelas IB e DXA foi avaliada pelo método de Bland & Altman e pelo coeficiente de correlação intraclasse (CCI). A média &#61617; desvio padrão de idade foi de 26,7 &#61617; 5,2 anos e o tempo médio da captação no pós-parto para a primeira avaliação foi de 2,6 &#61617; 2,0 meses e 8,0 &#61617; 2,7 meses para a segunda avaliação. A média de massa corporal (MC) foi de 74,6 &#61617; 11,4 kg na primeira avaliação e 75,1 &#61617; 12,6 kg na segunda avaliação, correspondendo a um valor de índice de massa corporal (IMC) de 28,8 &#61617; 4,0 kg/m2 e 29,0 &#61617; 4,6 kg/m2, respectivamente. O %GC medido pela DXA foi de 40,1 &#61617; 4,9 % para a primeira avaliação e de 41,0 &#61617; 5,2 %, para a segunda avaliação, representando uma MG de 30,2 &#61617; 6,6 kg e de 30,9 &#61617; 8,0 kg, respectivamente. Ambas as IB subestimaram a alteração do % GC (-0,7 % para IB_Tanita e -1,1% para IB_RJL) e MG (-0,6 kg para IB_Tanita e -1,0 kg IB_RJL) em relação ao DXA. Por sua vez, as alterações de MLG foram superestimadas 0,8 kg pela IB_Tanita e 1,0 kg IB_RJL. Houve boa concordância (CCI &#8805; 0,75) entre as alterações identificadas para MG pela IB_Tanita e por DXA e satisfatória pela IB_RJL. Dessa forma o presente estudo verificou um desempenho satisfatório da técnica de IB em identificar as alterações da MG gorda e que a IB_Tanita mostrou-se melhor que a IB_RJL na estimativa da alteração desse componente corporal nesse grupo de mulheres pós-parto. / The aim of the present study is to assure that the measurement of the bioelectrical impedance (IB) identifies the changes in the body composition of postpartum women. Forty-seven women (&#8805; 18 years of age) were enrolled in the study. Body composition (BC) - fat free mass (FFM), fat mass (FM) and percentage body fat (%BF) - was obtained by two IB devices (Tanita BC 533 and RJL 101) and DXA. All measurements were performed at the same day in two different postpartum moments. The women were categorized in two groups: with weight loss (WWL, n= 24) and with weight gain (WWG, n= 22). Pair T-test was used to compare mean difference values within methods and DXA. Bland & Altman plots and intraclass correlation coefficients (ICC) were used to evaluate the agreement between body composition changes obtained by both IB and DXA. The first and second visits for BC measurements occurred 2,6 &#61617; 2,0 months e 8,0 &#61617; 2,7 months after delivery, respectively. Mean ( SD) age was 26.7 &#61617; 5.2 years and body mass was 74.6 &#61617; 11.4 kg at the first visit and 75.1 &#61617; 12.6 kg at the second visit. Women were overweight in both visits (BMI= 28.8 &#61617; 4,0kg/m2 e 29.0 &#61617; 4.6 kg/m2). % BF measured by DXA at the first visit was 40.1 &#61617; 4.9% and at the second visit was 41.0 &#61617; 5.2% yielding on average a FM of 30.2 &#61617; 6,6 kg and 30,9 &#61617; 8,0 kg, respectively.. IB_Tantia yelded lower mean values for FFM and FM compare to DXA mean values, except for %BF. Both IB underestimated %BF (-0.7% for Tanita and -1.1% for RJL) and FM changes (-0.6 kg for Tanita and -1.0 for RJL) compared to DXA changes. On the other hand FFM changes were overestimated by Tanita (0,8 kg) and RJL (1,0 kg). There was a good agreement (CCI &#8805; 0.75) between FM changes measured by IB_Tanita and DXA and a fair agreement for IB_RJL. Therefore the IB technique was able to identified FM changes, and IB_Tanita showed a better performance than IB_RJL on the estimation of FM changes in these postpartum women.

Este trabalho teve como objetivo verificar se a técnica de impedância bioelétrica (IB) identifica as modificações da composição corporal em mulheres no período pós-parto. Participaram do estudo 47 mulheres (&#8805; 18 anos), nas quais foram avaliadas massa livre de gordura (MLG), massa gorda (MG) e percentual de gordura corporal (%GC) pelos equipamentos IB_Tanita BC 533; IB_RJL 101 e por absorciometria de raio X de dupla energia (DXA). Todas as avaliações foram feitas no mesmo dia. Posteriormente, as mulheres foram categorizadas em dois grupos: com perda ponderal (n= 24) e com ganho ponderal (n= 22). Os valores médios das alterações da composição corporal (CC), foram comparados intra-métodos e em relação ao método padrão-ouro (DXA) através de teste T-pareado. A concordância entre as diferenças das alterações da CC obtidas pelas IB e DXA foi avaliada pelo método de Bland & Altman e pelo coeficiente de correlação intraclasse (CCI). A média &#61617; desvio padrão de idade foi de 26,7 &#61617; 5,2 anos e o tempo médio da captação no pós-parto para a primeira avaliação foi de 2,6 &#61617; 2,0 meses e 8,0 &#61617; 2,7 meses para a segunda avaliação. A média de massa corporal (MC) foi de 74,6 &#61617; 11,4 kg na primeira avaliação e 75,1 &#61617; 12,6 kg na segunda avaliação, correspondendo a um valor de índice de massa corporal (IMC) de 28,8 &#61617; 4,0 kg/m2 e 29,0 &#61617; 4,6 kg/m2, respectivamente. O %GC medido pela DXA foi de 40,1 &#61617; 4,9 % para a primeira avaliação e de 41,0 &#61617; 5,2 %, para a segunda avaliação, representando uma MG de 30,2 &#61617; 6,6 kg e de 30,9 &#61617; 8,0 kg, respectivamente. Ambas as IB subestimaram a alteração do % GC (-0,7 % para IB_Tanita e -1,1% para IB_RJL) e MG (-0,6 kg para IB_Tanita e -1,0 kg IB_RJL) em relação ao DXA. Por sua vez, as alterações de MLG foram superestimadas 0,8 kg pela IB_Tanita e 1,0 kg IB_RJL. Houve boa concordância (CCI &#8805; 0,75) entre as alterações identificadas para MG pela IB_Tanita e por DXA e satisfatória pela IB_RJL. Dessa forma o presente estudo verificou um desempenho satisfatório da técnica de IB em identificar as alterações da MG gorda e que a IB_Tanita mostrou-se melhor que a IB_RJL na estimativa da alteração desse componente corporal nesse grupo de mulheres pós-parto. / The aim of the present study is to assure that the measurement of the bioelectrical impedance (IB) identifies the changes in the body composition of postpartum women. Forty-seven women (&#8805; 18 years of age) were enrolled in the study. Body composition (BC) - fat free mass (FFM), fat mass (FM) and percentage body fat (%BF) - was obtained by two IB devices (Tanita BC 533 and RJL 101) and DXA. All measurements were performed at the same day in two different postpartum moments. The women were categorized in two groups: with weight loss (WWL, n= 24) and with weight gain (WWG, n= 22). Pair T-test was used to compare mean difference values within methods and DXA. Bland & Altman plots and intraclass correlation coefficients (ICC) were used to evaluate the agreement between body composition changes obtained by both IB and DXA. The first and second visits for BC measurements occurred 2,6 &#61617; 2,0 months e 8,0 &#61617; 2,7 months after delivery, respectively. Mean ( SD) age was 26.7 &#61617; 5.2 years and body mass was 74.6 &#61617; 11.4 kg at the first visit and 75.1 &#61617; 12.6 kg at the second visit. Women were overweight in both visits (BMI= 28.8 &#61617; 4,0kg/m2 e 29.0 &#61617; 4.6 kg/m2). % BF measured by DXA at the first visit was 40.1 &#61617; 4.9% and at the second visit was 41.0 &#61617; 5.2% yielding on average a FM of 30.2 &#61617; 6,6 kg and 30,9 &#61617; 8,0 kg, respectively.. IB_Tantia yelded lower mean values for FFM and FM compare to DXA mean values, except for %BF. Both IB underestimated %BF (-0.7% for Tanita and -1.1% for RJL) and FM changes (-0.6 kg for Tanita and -1.0 for RJL) compared to DXA changes. On the other hand FFM changes were overestimated by Tanita (0,8 kg) and RJL (1,0 kg). There was a good agreement (CCI &#8805; 0.75) between FM changes measured by IB_Tanita and DXA and a fair agreement for IB_RJL. Therefore the IB technique was able to identified FM changes, and IB_Tanita showed a better performance than IB_RJL on the estimation of FM changes in these postpartum women.

Purpose. To evaluate the effect of Fit Kids for Life (FKFL), a multi-disciplinary exercise and nutrition intervention, on body composition, fitness levels, cardiovascular risk factors and quality of life among overweight and obese children. Subjects. Forty-eight overweight or obese children (BMI ≥ 85th percentile), ages 8-17, were matched by age and BMI and then randomized into an exercise or wait list control group. The groups were similar at baseline for age, gender and ethnicity (p>.05). Method. The exercise group trained for 60 minutes, two times per week for 10 weeks, then performed a 10 week home program. After 10 weeks of waiting to start, the control group began the 10 week exercise program followed by a 10 week home program. Body composition (dual energy X-ray absorptiometry), fitness measures, quality of life, and cardiovascular risk factors were assessed at baseline, at completion of the 10 week intervention and following the 10 week home program. Results. Body composition improved over time in both groups with significant changes in % body fat and % lean tissue noted between baseline and twenty weeks (p<.05). Fitness measures improved and changes were maintained or increased during the home program phase. Cardiovascular risk factors remained unchanged between groups and across time, with the exception of systolic blood pressure which increased at 10 weeks. The physical domain of the Impact of Quality of Life scale significantly improved following completion of the program (p<.05). Conclusions.Overweight and obese children who completed the 10 week FKFL program improved their body composition and fitness levels. The beneficial changes were sustained or improved following an additional 10 week home program. Recommendations. Overweight and obese children can benefit from a 10 week multidisciplinary exercise and nutrition program. The use of body composition methods and fitness measures may be better indicators of program effectiveness.

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Dual energy X-ray absorptiometry (DXA) has been well established in both clinical and research settings for measurement of bone mineral density (BMD), and is becoming more widely utilized for assessment of body composition. Reliability and validity are essential factors in both applications of this technique; however, neither have been confirmed for the QDR-4500A DXA at Virginia Tech. Therefore, measurements of the whole body (WB), lumbar spine (LS), total proximal femur (TPF) and total forearm (TF) were made in a group of young-adult males and females at two time-points, 5-7 days apart. Significant differences were not found in BMD (g/cm2) at these body sites with repeated measurements by DXA. Furthermore, measures of percent body fat (%BF), lean body mass (LBM), and fat mass (FM) by DXA were reliable. Validity of %BF by DXA was assessed from comparison to single-frequency bioelectrical impedance analysis (BIA). Significant differences were not found in measures of %BF by DXA and BIA. A second study investigated the reliability and validity of the QDR-4500A DXA in measurements of distal tibia (DT) BMD. Significant differences were not found between repeated measurements. Validity was established by a significant correlation between WB BMD and DT BMD. A third study examined the influence of navel jewelry on the accuracy of LS DXA measurements. Repeated measurements with a spine phantom revealed that both a navel ring and a barbell produced significantly greater measures of LS BMD compared to the spine phantom alone. Manual correction of navel jewelry did not eliminate BMD inaccuracies. Data from these studies confirmed that the QDR-4500A DXA at Virginia Tech was a reliable and valid device in measurement of WB, LS, TPF, TF and DT BMD, as well as %BF, LBM, and FM. In addition, effects of navel jewelry on LS BMD have been recognized. Further studies investigating the reliability and validity of DT BMD measures as well as effects of different types, gauges, and shapes of body jewelry on BMD measures in human subjects are warranted. / Master of Science